Network system for automated seizure detection and contingent delivery of therapy.

The authors describe an integrated bedside system for real-time seizure detection and automated delivery of electrical stimulation directly to the brain of subjects undergoing invasive epilepsy surgery evaluation. These stimulations were triggered by specific detections following a prespecified pattern. The system uses a commercially available EEG unit, two personal computers, two Grass S-12 stimulators, and other custom-built units to enable interfacing between these components. To date, more than 9,500 hours of electrocorticographic data have been acquired, displayed, and analyzed, and more than 900 closed-loop stimulations for seizure blockage have been delivered safely and reliably to eight subjects with intractable epilepsy. This system generates on-line reports containing information about seizures that provide the epileptologist with timely, valuable data while allowing adaptation of the algorithm detection parameters to improve its performance if necessary. Additionally, it can control the output of any therapeutic device and administrate automatically cognitive tests or radioactive tracers for neuroimaging purposes. This network system, which can be replicated at a relatively low cost by others, is proof of concept for a portable or implantable device that could serve identical functions. Widespread availability of this type of system will advance the fields of clinical and basic epilepsy rapidly and considerably.

Prevention of self-inflicted trauma in comatose patients.

A solution to the problem of self-inflicted trauma to the tongue in decerebrate and comatose patients is outlined. The neurophysiology of jaw movement in the comatose patient is the basis of design of an intraoral fixed appliance which prevents discoordinate or neuropathologic mandibular chewing movements and facilitates healing of pre-existing lesions. Described in detail are the fabrication, insertion, and maintenance of this protective prosthesis, with emphasis on the need for joint effort between the neurosurgery and dentistry teams.

Dental prosthesis as an unsuspected foreign body.

Ingested or aspirated dental prostheses may cause dysphagia and respiratory obstructions. We present the case of a patient with dementia who had a dental prosthesis lodged in his hypopharynx. This patient had routine radiologic studies and diagnostic scans to rule out primary and metastatic disease, was placed on total parenteral nutrition, and underwent several endoscopies before his dysphagia was related to aspiration of a dental prosthesis. The prosthesis was evident on radiologic examination, but was overlooked by the admitting service in the patient's differential diagnosis. After removal of the appliance, the patient had an uneventful recovery and was discharged after a 22-day hospital stay. Early diagnosis and definitive patient treatment depends on prompt recognition. The importance of recognizing the radiographic appearance of a dental prosthesis is emphasized.